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1.
Isr Med Assoc J ; 21(8): 565-567, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31474024

RESUMO

BACKGROUND: Global trends, such as the population aging, the increase of chronic morbidity, soaring costs of healthcare services, and work overload in hospitals raise the need to find innovative solutions for providing quality medical services. One solution adopted by healthcare systems around the world is "home hospitalization," that is, providing an array of necessary health services in the patient's home, instead of in the hospital department. The aim of this focus article is to explore the spread of home hospitalization worldwide and examine the challenges and pathways for its adoption and implementation. Many countries, including the United States, Canada, the United Kingdom, and Australia, operate home-based hospitalization programs. In Israel, the service is in its infancy, but in view of the extreme workload and the high mortality rate from infections in acute care hospitals, home hospitalization has recently gained public interest and political support, which may encourage its further development.


Assuntos
Serviços de Assistência Domiciliar , Hospitais , Austrália , Canadá , Humanos , Internacionalidade , Israel , Reino Unido , Estados Unidos
2.
Isr Med Assoc J ; 21(8): 538-541, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31474016

RESUMO

BACKGROUND: Travelers' diarrhea (TD) is frequently encountered in people traveling from high-income to low-income countries; however, its epidemiology in those traveling between high-income countries is not known. OBJECTIVES: To evaluate the incidence of diarrhea in North American students relocating to Israel. METHODS: A retrospective cohort study involving medical students from the United States and Canada relocating to Israel was conducted. Students who relocated to Israel during 2010-2016 were contacted by email to participate in an anonymous survey. Data included demographic information as well as occurrence, timing, duration, and outcome of diarrhea after relocation. RESULTS: Ninety-seven students participated in the survey. Most (93.7%) students relocated from the United States or Canada. The period-prevalence of diarrhea was 69.1%. The incidence of diarrhea declined from 34.8 cases per 100 student-months during the first month after relocation to 1.3 cases per 100 student-months after 1 year. The duration of diarrhea was up to 1 week in 72.7%. Students who reported diarrhea were younger than students who did not (mean age 24.0 ± 2.2 and 28.4 ± 1.8 years, respectively, P < 0.001). No other demographic parameter was significantly associated with a higher likelihood of diarrhea. CONCLUSIONS: A high proportion of North American medical students relocating to Israel reported diarrhea with clinical and epidemiological features similar to classic TD. Further studies are needed to elucidate the causative agents of TD in Israel.


Assuntos
Diarreia/epidemiologia , Inquéritos Epidemiológicos/estatística & dados numéricos , Estudantes/estatística & dados numéricos , Doença Relacionada a Viagens , Doença Aguda , Adulto , Canadá/etnologia , Estudos de Coortes , Diarreia/etnologia , Feminino , Humanos , Incidência , Israel/epidemiologia , Masculino , Projetos Piloto , Estudos Retrospectivos , Viagem , Estados Unidos/etnologia , Adulto Jovem
5.
Stud Health Technol Inform ; 264: 1106-1110, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438096

RESUMO

Patient portals are offered by health care organizations to facilitate health information sharing and patient empowerment and support patient-centered care. The aim of this systematic review is to assess the effect of patient portals on patient empowerment and health-related outcomes. After a systematic literature search, ten randomized controlled trials (RCTs) were included in this review. Of these, seven RCTs were conducted in the United States., two in Canada, and one in Japan. Study characteristics, risk of bias, and outcomes were extracted. varied in terms of intervention, included patients, and outcome. Most studies found no or only a small, clinically non-relevant effect of patient portals. The review showed that future research should develop a taxonomy to describe patient portal functionalities to facilitate the aggregation of evidence.


Assuntos
Participação do Paciente , Portais do Paciente , Adulto , Canadá , Humanos , Japão
6.
Rev Lat Am Enfermagem ; 27: e3162, 2019 Aug 19.
Artigo em Português, Inglês, Espanhol | MEDLINE | ID: mdl-31432917

RESUMO

OBJECTIVE: to describe the activities developed by the liaison nurses for the continuity of care after hospital discharge. METHOD: descriptive, qualitative study, based on the theoretical reference. Strength Based Care. The sample comprised 23 liaison nurses. The data was collected through a semi-structured questionnaire via Survey Monkey electronic platform and analyzed through the content analysis technique, with pre-defined categories. RESULTS: among the liaison nurses, nine (39.14%), between 35 and 44 years of age; 17 (73.91%) were female; 15 (65.22%) were working eleven years or more nurse and 11 (47.82%), were between six and ten years old as a liaison nurse. The professionals participate in the identification of the patients who need care after hospital discharge, coordinate the planning of the hospital discharge and transfer the patient's information to an extra-hospital service. CONCLUSION: the activities developed by the liaison nurses focus on the needs of the patient and the articulation with the extra-hospital services, and can be adapted to the Brazilian context as a strategy to minimize the discontinuity of care at the time of hospital discharge.


Assuntos
Continuidade da Assistência ao Paciente/normas , Papel do Profissional de Enfermagem , Recursos Humanos de Enfermagem no Hospital/normas , Alta do Paciente/estatística & dados numéricos , Adulto , Brasil , Canadá , Feminino , Hospitais Universitários , Humanos , Masculino , Transferência de Pacientes , Pesquisa Qualitativa , Inquéritos e Questionários
7.
Can Assoc Radiol J ; 70(3): 212-218, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31376884

RESUMO

PURPOSE: Secondary usage of patient data has recently become of increasing interest for the development and application of computer analytic techniques. Strict oversight of these data is required and the individual patients themselves are integral to providing guidance. We sought to understand patients' attitudes to sharing their imaging data for research purposes. These images could provide a great wealth of information for researchers. METHODS: Patients from the Greater Toronto Area attending Sunnybrook Health Sciences Centre for imaging (magnetic resonance imagining, computed tomography, or ultrasound) examination areas were invited to participate in an electronic survey. RESULTS: Of the 1083 patients who were approached (computed tomography 609, ultrasound 314, and magnetic resonance imaging 160), 798 (74%) agreed to take the survey. Overall median age was 60 (interquartile range = 18, Q1 = 52, Q3 = 70), 52% were women, 42% had a university degree, and 7% had no high school diploma. In terms of willingness to share de-identified medical images for research, 76% were willing (agreed and strongly agreed), while 7% refused. Most participants gave their family physicians (73%) and other physicians (57%) unconditional data access. Participants chose hospitals/research institutions to regulate electronic images databases (70%), 89% wanted safeguards against unauthorized access to their data, and over 70% wanted control over who will be permitted, for how long, and the ability to revoke that permission. CONCLUSIONS: Our study found that people are willing to share their clinically acquired de-identified medical images for research studies provided that they have control over permissions and duration of access.


Assuntos
Confidencialidade/psicologia , Diagnóstico por Imagem/psicologia , Registros Eletrônicos de Saúde/estatística & dados numéricos , Troca de Informação em Saúde/estatística & dados numéricos , Opinião Pública , Sujeitos da Pesquisa/psicologia , Adolescente , Adulto , Fatores Etários , Idoso , Canadá , Segurança Computacional , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Fatores de Tempo , Adulto Jovem
8.
Dis Aquat Organ ; 135(2): 127-134, 2019 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-31392965

RESUMO

Francisella halioticida is a marine bacterium originally described as the causative agent of mass mortality among giant abalone Haliotis gigantea. Recent field studies in Canada and Japan have suggested that this bacterium is also the cause of adductor muscle lesions and high mortality of Yesso scallops Patinopecten yessoensis, although a causal relationship has not been established. In the present study, the pathogenicity of F. halioticida in Yesso scallops was assessed in both Canada and Japan using bacteria isolated from diseased Yesso scallops in each respective country. Independent laboratory experiments revealed that scallops challenged with F. halioticida via bath exposure resulted in high mortality and histological lesions characterized by massive haemocyte infiltration. The presence of F. halioticida was confirmed using PCR, and F. halioticida was re-isolated from a portion of dead and surviving specimens. These results fulfill Koch's classic criteria for establishing disease causation and provide conclusive evidence that F. halioticida causes adductor muscle lesions and high mortality in Yesso scallops.


Assuntos
Francisella , Pectinidae , Animais , Canadá , Japão , Filogenia
9.
Stud Health Technol Inform ; 264: 709-713, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438016

RESUMO

Health information exchange (HIE) is seen as an essential technology for improving health care quality and efficiency by allowing exchange of patient-centered data over time and across organizations. The objective of this study was to evaluate the usage and the perceived usefulness of a nationwide HIE in a centralized model that was implemented in 2013 in the province of Quebec, Canada. A mixed-method study was conducted with a longitudinal descriptive analysis of usage data combined with in-depth comparative case study in four selected primary care organizations and two emergency departments. Perceived benefits were reported by users across all dimensions of care performance, including accessibility, efficiency, quality and safety, and patient experience; however, the experience of users was very heterogeneous and strongly associated with the commercial electronic record system available in their work place and the implementation strategy.


Assuntos
Troca de Informação em Saúde , Canadá , Registros Eletrônicos de Saúde , Humanos , Atenção Primária à Saúde , Quebeque
10.
Stud Health Technol Inform ; 264: 714-718, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438017

RESUMO

Electronic prescribing, defined as the electronic generation and transmission of a medication order for community-dwelling patients, is presented as an essential technology to improve medication use. The objective of this study was to evaluate a nationwide e-prescribing system in Quebec, Canada. A mixed-method study was conducted from July 2017 until June 2018. A descriptive analysis of e-prescription usage was performed using aggregated usage data, combined with an exploratory descriptive analysis of the e-prescribing system from the perspective of users of two electronic health records (EHR) and pharmacy management systems (PMS) (n=9 prescribers; 8 pharmacy technicians and 11 pharmacists). Overall, the adoption of the system was low, with only 2% of prescriptions being electronically transmitted and retrieved during the study period. Alignment problems were identified on the prescriber's and receiver's side, generating safety issues, and hindering the potential for benefits realization.


Assuntos
Prescrição Eletrônica , Canadá , Humanos , Erros de Medicação , Farmacêuticos , Quebeque
11.
Stud Health Technol Inform ; 264: 1984-1985, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438440

RESUMO

There has been a significant increase in the volume of research conducted on patient portals in recent years. Similarly, there has been a number of benefits described in the literature when patients are engaged in research at all stages. This poster will provide an overview of three ways that patients can be engaged in patient portal research. The methods are based on those used in mental health patient portal research in Canada.


Assuntos
Portais do Paciente , Canadá , Cuidadores , Humanos , Pesquisa
13.
Gastroenterology ; 157(2): 320-348, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31320109

RESUMO

BACKGROUND & AIMS: We aim to provide guidance for medical treatment of luminal Crohn's disease in children. METHODS: We performed a systematic search of publication databases to identify studies of medical management of pediatric Crohn's disease. Quality of evidence and strength of recommendations were rated according to the GRADE (Grading of Recommendation Assessment, Development, and Evaluation) approach. We developed statements through an iterative online platform and then finalized and voted on them. RESULTS: The consensus includes 25 statements focused on medical treatment options. Consensus was not reached, and no recommendations were made, for 14 additional statements, largely due to lack of evidence. The group suggested corticosteroid therapies (including budesonide for mild to moderate disease). The group suggested exclusive enteral nutrition for induction therapy and biologic tumor necrosis factor antagonists for induction and maintenance therapy at diagnosis or at early stages of severe disease, and for patients failed by steroid and immunosuppressant induction therapies. The group recommended against the use of oral 5-aminosalicylate for induction or maintenance therapy in patients with moderate disease, and recommended against thiopurines for induction therapy, corticosteroids for maintenance therapy, and cannabis in any role. The group was unable to clearly define the role of concomitant immunosuppressants during initiation therapy with a biologic agent, although thiopurine combinations are not recommended for male patients. No consensus was reached on the role of aminosalicylates in treatment of patients with mild disease, antibiotics or vedolizumab for induction or maintenance therapy, or methotrexate for induction therapy. Patients in clinical remission who are receiving immunomodulators should be assessed for mucosal healing within 1 year of treatment initiation. CONCLUSIONS: Evidence-based medical treatment of Crohn's disease in children is recommended, with thorough ongoing assessments to define treatment success.


Assuntos
Doença de Crohn/tratamento farmacológico , Medicina Baseada em Evidências/normas , Gastroenterologia/normas , Fármacos Gastrointestinais/uso terapêutico , Sociedades Médicas/normas , Canadá , Criança , Medicina Baseada em Evidências/métodos , Gastroenterologia/métodos , Humanos , Resultado do Tratamento
14.
Gan To Kagaku Ryoho ; 46(7): 1103-1108, 2019 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-31296811

RESUMO

Li-Fraumeni syndrome(LFS)is a cancer predisposing disorder with early-onset cancers in diverse tissues of origin, caused by germline TP53 mutation. In LFS, 5 core cancers are known: breast cancer, soft tissue sarcoma, osteosarcoma, brain tumor, adrenocortical cancer. Surveillance for LFS must be lifetime long and multitargeted since the patients are susceptible to various cancers from infant to middle-aged and older. Recent investigations have revealed germline TP53 mutations can increase the riskfor radio-induced tumorigenesis and will affect patient's prognosis and treatment in several cancers. The surveillance protocol has developed in Canada and several prospective studies based on the Canadian's one are currently being carried out. We are aware that the surveillance protocol suitable for the current status in Japan is urgently needed to provide the appropriate medical care for LFS patients.


Assuntos
Neoplasias Ósseas , Síndrome de Li-Fraumeni , Canadá , Predisposição Genética para Doença , Humanos , Japão , Estudos Prospectivos , Proteína Supressora de Tumor p53
15.
BMC Infect Dis ; 19(1): 594, 2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31286891

RESUMO

BACKGROUND: People aging with HIV can experience a variety of health challenges associated with HIV and multimorbidity, referred to as 'disability'. Our aim was to characterize the disability experience and examine relationships between dimensions of disability among adults living with HIV. METHODS: We performed a structural equation modeling analysis with data from the Canadian web-based HIV, Health and Rehabilitation Survey. We measured disability using the HIV Disability Questionnaire (HDQ), a patient-reported outcome (69 items) that measures presence, severity and episodic features of disability across six domains: 1) physical symptoms, 2) cognitive symptoms, 3) mental-emotional health symptoms, 4) difficulties carrying out day-to-day activities, 5) uncertainty and worrying about the future, and 6) challenges to social inclusion. We used HDQ severity domain scores to represent disability dimensions and developed a structural model to assess relationships between disability dimensions using path analysis. We determined overall model fit with a Root Mean Square Error of Approximation (RMSEA) of < 0.05. We classified path coefficients of ≥ 0.2-0.5 as a medium (moderate) effect and > 0.5 a large (strong) effect. We used Mplus software for the analysis. RESULTS: Of the 941 respondents, most (79%) were men, taking combination antiretroviral medications (90%) and living with two or more simultaneous health conditions (72%). Highest HDQ presence and severity scores were in the uncertainty domain. The measurement model had good overall fit (RMSEA= 0.04). Results from the structural model identified physical symptoms as a strong direct predictor of having difficulties carrying out day-to-day activities (standardized path coefficient: 0.54; p < 0.001) and moderate predictor of having mental-emotional health symptoms (0.24; p < 0.001) and uncertainty (0.36; p < 0.001). Uncertainty was a strong direct predictor of having mental-emotional health symptoms (0.53; p < 0.001) and moderate direct predictor of having challenges to social inclusion (0.38; p < 0.001). The relationship from physical and cognitive symptoms to challenges to social inclusion was mediated by uncertainty, mental-emotional health symptoms, and difficulties carrying out day-to-day activities (total indirect effect from physical: 0.22; from cognitive: 0.18; p < 0.001). CONCLUSIONS: Uncertainty is a principal dimension of disability experienced by adults with HIV. Findings provide a foundation for clinicians and researchers to conceptualize disability and identifying areas to target interventions.


Assuntos
Infecções por HIV , Inquéritos Epidemiológicos , Canadá , Avaliação da Deficiência , Infecções por HIV/epidemiologia , Infecções por HIV/psicologia , Infecções por HIV/reabilitação , Inquéritos Epidemiológicos/métodos , Inquéritos Epidemiológicos/normas , Humanos , Internet , Inquéritos e Questionários
16.
Women Birth ; 32(5): 412-426, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31262706

RESUMO

BACKGROUND: Culturally secure care is considered foundational for good perinatal outcomes for Indigenous women. It is unknown what literature reports on whether Indigenous women giving birth in urban areas receives appropriate cultural care. The aim of this scoping review was to examine and summarise relevant evidence which reports on culturally secure care for Indigenous women using urban maternity services at any time during the perinatal period. METHODS: Ten journal databases plus grey literature and theses databases were searched for relevant material dated 1986-2018. Articles were included if they were about Indigenous women from Australia, New Zealand, Canada or the USA; care was provided anytime during the perinatal period, in an urban area; and cultural security (or variations of this term) were used. RESULTS: 6856 titles and abstracts were screened, of these: 25 studies, 15 grey literature documents and 9 theses matched the search criteria. Studies were mostly qualitative (13/25) and from Australia (18/25). Studies showed women's access to and experiences of culturally secure maternity care in urban areas as variable. The grey literature originated from Australia (8/15); New Zealand (4/15); and Canada (3/15); while theses were from Canada (7/9) and Australia (2/9). CONCLUSION: The scoping review results showed substantial qualitative evidence on Indigenous women's experience during the perinatal period in urban areas. In-depth analysis of these studies is required to inform future practice and policy on what works and what needs improvement. Culturally secure midwifery care shows promising results.


Assuntos
Assistência à Saúde Culturalmente Competente , Assistência à Saúde/organização & administração , Serviços de Saúde do Indígena/organização & administração , Tocologia/métodos , Assistência Perinatal , Austrália , Canadá , Competência Cultural , Assistência à Saúde/métodos , Feminino , Humanos , Nova Zelândia , Parto , Gravidez , População Urbana
18.
Waste Manag Res ; 37(9): 885-897, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31333076

RESUMO

Production, quality and quality assurance, as well as co-incineration of solid recovered fuels in cement industry, have become state-of-the-art in the European cement industry. At the global level, average thermal substitution rate is about 17%, whereby, only 13% in Canada and in the USA 16%, while in the European Union 28 it is about 44% (i.e. 11,300,000 t waste fuels utilised in 2016). In Austria, thermal substitution rate was ca. 80% in 2017, which was worldwide the highest one. Regarding solid recovered fuels for the cement industry, two types are relevant, namely solid recovered fuels PREMIUM Quality and solid recovered fuels MEDIUM Quality. In the case study shown, solid recovered fuels PREMIUM Quality from 11 and solid recovered fuels MEDIUM Quality from nine different solid recovered fuels production plants have been investigated. Investigations consist of sorting and sieving analyses (for PREMIUM), as well as physical-chemical analyses (for both solid recovered fuels types) according to the (inter)national standards (i.e. Austrian 'ÖNORM', European 'EN' standards and CEN TC 343 guidelines). The results gained from the first investigation were published in 2014 and here, results of further investigations are updated for 2016 and 2018 and confronted with legal and market relevant requirements. During the investigation, not enough parallel samples could be investigated and therefore no adequate scientific statistical analyses could be elaborated but a more practical indicative interpretation has been made. Finally, it can be confirmed, that all investigated solid recovered fuels fulfil the Austrian legal and international solid recovered fuels and co-incineration market requirements.


Assuntos
Eliminação de Resíduos , Áustria , Canadá , Combustíveis Fósseis , Fósseis , Incineração
20.
Can Assoc Radiol J ; 70(3): 226-232, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31255393

RESUMO

In 2017, the Canadian Association of Radiologists issued a clinical practice guideline (CPG) regarding the use of gadolinium-based contrast agents (GBCAs) in patients with acute kidney injury (AKI), chronic kidney disease (CKD), or on dialysis due to mounting evidence indicating that nephrogenic systemic fibrosis (NSF) occurs with extreme rarity or not at all when using Group II GBCAs or the Group III GBCA gadoxetic acid (compared to first generation Group I linear GBCAs). One of the goals of the work group was to re-evaluate the CPG after 24 months to determine the effect of more liberal use of GBCA on reported cases of NSF in patients with AKI, CKD Stage 4 or 5 (estimated glomerular filtration rate [eGFR] < 30 mL/min/1.73 m2), or those that are dialysis-dependent. A comprehensive review of the literature was conducted by a subcommittee of the initial CPG panel between the dates of January 1, 2017-December 31, 2018 to identify new unconfounded cases of NSF linked to Group II or Group III GBCAs and an updated CPG developed. To our knowledge, when using a Group II or Group III GBCA between 2017-2018, only a single unconfounded case report of a fibrosing dermopathy has been reported in a patient who received gadobenate dimeglumine with Stage 2 CKD. No other unconfounded cases of NSF have been reported with Group II or III agents in during this timeframe. The subcommittee concluded that the main recommendations from the 2017 CPG should remain unaltered, but agreed that screening for renal disease in the outpatient setting is no longer justifiable, cost-effective or recommended. Patients on hemodialysis (HD) should, however, be identified prior to GBCA administration to arrange timely HD to optimize gadolinium clearance, although there remains no evidence that HD reduces the risk of NSF. When administering Group II or III GBCAs to patients with AKI, on dialysis or with severe CKD, informed consent relating to NSF is also no longer explicitly recommended.


Assuntos
Meios de Contraste , Gadolínio , Aumento da Imagem/métodos , Nefropatias/diagnóstico por imagem , Imagem por Ressonância Magnética , Canadá , Humanos , Rim/diagnóstico por imagem , Radiologistas , Sociedades Médicas
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